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Texas Medicaid Pharmacy Services
Texas Vendor Drug The Texas Vendor Drug Program manages the state Medicaid and CHIP formularies. We also process out-patient pharmacy claims for people enrolled in:
Pharmacy providers must enroll with HHSC through the Provider Enrollment and Management System (PEMS) before providing any outpatient pharmacy prescription services. A pharmacy must enroll prior to participation in managed care. All traditional Medicaid outpatient prescription claims are processed through a real-time, point-of-sale system using the National Council for Prescription Drug Programs telecommunication standard format. All claim submission requirements are available in the Pharmacy Provider Procedure Manual. Payment is posted weekly. Pharmacy providers can also use our electronic eligibility verification tools to obtain prescription benefit information and managed care health plan coverage. The claim system undergoes regularly-scheduled weekly maintenance. Notification of extended or expanded maintenance periods will be sent to pharmacy providers. Not receiving our notices? The pharmacy should ensure its enrollment information is current and report any changes. HHSC is available to assist pharmacy providers with claim submissions and information regarding program policies and procedures. Register or Sign In Providers, Billing Agents, and Clearinghouses who have an existing account can sign in to access the secure functions of the portal and account information. Username and Password Once a Provider, Billing Agent, Clearinghouse creates their Trading Partner Account (TPA), they will need to enter the TPA username and password to access the secure section of the portal. Password Reset or Username Retrieval Providers, Billing Agents, can reset their passwords by using their registered email addresses which were provided during portal registration. An email is sent to the registered email account on file, providing a web link to reset the account password. A registered user can retrieve a forgotten username by correctly using registered email addresses that are entered during the registration process. The username is sent to the registered email account as listed during the registration process. Contact Support - Gainwell Technologies For Pharmacy Technical Support, call 1-800-435-4165, Monday - Friday, 7:00 a.m.-7:00 p.m. Central Time. For Prior Authorizations, call 1-877-728-3927, Monday - Friday, 7:00 a.m.-7:00 p.m. Central Time. Registered users of this portal may sign into their account to chat with an agent and access information, print forms, or submit claims online. Provider Access This tab provides access to Provider announcements, information, documents, and links of interest specifically for Providers and Trading Partners. The secure section of the Texas Medicaid Pharmacy portal enables authorized, registered Trading Partners to submit pharmacy claims, prior authorization requests, check Member eligibility, and review claim payment status. Trading Partner Access Providers, Billing Agents, and Clearinghouses must register to access the Provider enrollment application. Pharmacies and prescribing Providers must be enrolled with Texas Medicaid prior to registering as a Trading Partner. Trading Partner account registration/activation enables access to the secure Provider portal for direct data entry of claims and prior authorizations, Member eligibility inquiries, claim status inquiries, remittance advice, and more. Pharmacy Directory To search for an enrolled Pharmacy Provider, select the Pharmacy Directory from the drop-down menu on the Texas Medicaid Pharmacy Online banner. Navigation Tab - General The general tab provides information to Texas Medicaid Providers, Trading Partners, and the Public such as Announcements, Medicaid News and a Pharmacy Directory. There are external links on this tab to the Texas Department of Medicaid website. |